Psychopharmacology Practice Questions

Q: Retrograde ejaculation is a characteristic side effect of which psychotropic medication?

Thioridazine. **Explanation:** **Thioridazine** is a low-potency typical antipsychotic known for its significant alpha-1 adrenergic blocking properties. Retrograde ejaculation occurs because the closure of the internal urethral sphincter (bladder neck) is mediated by alpha-1 receptors. When these receptors are blocked, the sphincter fails to close during ejaculation, causing semen to travel backward into the bladder instead of out through the urethra. This is a classic, high-yield side effect specifically associated with Thioridazine. **Analysis of Incorrect Options:** * **Lithium carbonate:** Primarily causes side effects like tremors, polyuria (nephrogenic diabetes insipidus), and hypothyroidism. It does not significantly affect the adrenergic system governing ejaculation. * **Phenelzine:** An MAO inhibitor. While it can cause sexual dysfunction (primarily delayed ejaculation or impotence), it is not classically associated with retrograde ejaculation. * **Diazepam:** A benzodiazepine that acts via GABA-A receptors. It may cause decreased libido or erectile dysfunction due to CNS sedation but does not cause the mechanical failure seen in retrograde ejaculation. **Clinical Pearls for NEET-PG:** * **Thioridazine "Mnemonic":** Remember the **"3 Ts"** of Thioridazine: **T**orsades de pointes (QT prolongation), **T**errible Retinitis Pigmentosa (at doses >800mg/day), and **T**ermination of forward ejaculation (Retrograde). * **Mechanism:** Retrograde ejaculation is an **alpha-adrenergic blockade** phenomenon. * **Other drugs:** Apart from Thioridazine, alpha-blockers like **Tamsulosin** (used in BPH) are also common causes of retrograde ejaculation.

Q: Which of the following medications are used in the treatment of hyperkinetic syndrome?

Methylphenidate and Amphetamine. **Explanation:** **Hyperkinetic Syndrome**, commonly known as **Attention Deficit Hyperactivity Disorder (ADHD)**, is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. The primary pathophysiology involves a dysfunction in the catecholaminergic systems (dopamine and norepinephrine) within the prefrontal cortex. **Why Option C is Correct:** The first-line pharmacological treatment for ADHD is **Psychostimulants**. * **Methylphenidate:** It acts by blocking the reuptake of dopamine and norepinephrine (inhibiting DAT and NET transporters). * **Amphetamines:** These increase the release of dopamine and norepinephrine from presynaptic nerve terminals. Both medications enhance catecholamine signaling in the prefrontal cortex, thereby improving focus and executive function. **Why Other Options are Incorrect:** * **Option A & B:** **Imipramine** (a Tricyclic Antidepressant) is considered a second or third-line agent for ADHD, used only when stimulants are ineffective or contraindicated. **Clozapine** is an atypical antipsychotic used for treatment-resistant schizophrenia and has no role in treating ADHD. * **Option D:** **Haloperidol** (a typical antipsychotic) and **Clozapine** are dopamine antagonists. Since ADHD requires an *increase* in synaptic dopamine, these drugs are not indicated and may actually worsen symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Methylphenidate is the most commonly used first-line agent. * **Non-Stimulant DOC:** **Atomoxetine** (a selective norepinephrine reuptake inhibitor) is the preferred non-stimulant, especially in patients with a history of substance abuse or tics. * **Common Side Effects:** Insomnia, decreased appetite, weight loss, and growth retardation (requires "drug holidays"). * **Age of Onset:** According to DSM-5, symptoms must be present before the **age of 12**.

Q: What is the best drug therapy for paranoid schizophrenia in a thinly built 21-year-old young male?

Olanzapine. **Explanation:** The correct answer is **Olanzapine (Option C)**. The clinical scenario describes a **thinly built** young male. In psychiatric practice, the side-effect profile of a drug often dictates the choice of therapy. Olanzapine is a highly effective Second-Generation Antipsychotic (SGA) known for its significant side effect of **weight gain** and metabolic syndrome. In a patient who is underweight or "thinly built," this side effect is clinically leveraged to help the patient achieve a healthier BMI while managing psychotic symptoms. Olanzapine also has a lower risk of Extrapyramidal Symptoms (EPS) compared to typical antipsychotics, making it ideal for a young patient. **Analysis of Incorrect Options:** * **Chlorpromazine (Option A):** A low-potency First-Generation Antipsychotic (FGA). It is rarely the first choice today due to heavy sedation, significant anticholinergic effects, and the risk of postural hypotension. * **Risperidone (Option B):** While effective, it has a higher propensity for causing EPS and hyperprolactinemia (which can cause gynecomastia in males) compared to Olanzapine. * **Quetiapine (Option D):** Generally less potent than Olanzapine and often requires high doses for schizophrenia. It is more commonly used when sedation is the primary goal or in Parkinson’s disease-associated psychosis. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for Schizophrenia:** Generally SGAs (like Olanzapine or Risperidone) are preferred over FGAs due to lower EPS risk. * **Refractory Schizophrenia:** Clozapine is the DOC (requires mandatory WBC monitoring for agranulocytosis). * **Weight Gain Hierarchy:** Clozapine > Olanzapine > Quetiapine > Risperidone > Ziprasidone/Aripiprazole (Weight neutral). * **Hyperprolactinemia:** Most common with Risperidone and FGAs (Haloperidol).

Q: A 26-year-old lady has just recovered from an acute manic episode and has a diagnosis of bipolar affective disorder. Which one of the following medications is not used for the prophylaxis of this condition?

Chlorpromazine. **Explanation:** The management of Bipolar Affective Disorder (BPAD) is divided into two phases: **Acute treatment** (to control current symptoms) and **Maintenance/Prophylaxis** (to prevent future relapses). **Why Chlorpromazine is the correct answer:** Chlorpromazine is a typical (first-generation) antipsychotic. While it is highly effective in the **acute management** of manic episodes due to its sedative and dopamine-blocking properties, it is **not used for long-term prophylaxis**. Long-term use of typical antipsychotics is avoided in BPAD maintenance due to the risk of extrapyramidal side effects (EPS), tardive dyskinesia, and the potential to worsen depressive symptoms. **Analysis of incorrect options (Prophylactic agents):** * **Lithium (Option B):** The "Gold Standard" for prophylaxis. It is effective in preventing both manic and depressive relapses and is the only drug proven to reduce suicide risk in BPAD. * **Semisodium Valproate (Option C):** A first-line mood stabilizer, particularly effective for rapid cycling and mixed episodes. * **Carbamazepine (Option A):** Used as a second-line prophylactic agent, especially in patients who do not respond to Lithium or Valproate. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Prophylaxis:** Lithium, Valproate, or Quetiapine. * **Lamotrigine:** Primarily used for the prophylaxis of the **depressive phase** of BPAD (not effective for acute mania). * **Therapeutic Window of Lithium:** 0.8–1.2 mEq/L for acute mania; **0.6–1.0 mEq/L** for prophylaxis. * **Atypical Antipsychotics:** Unlike Chlorpromazine, certain atypical antipsychotics (e.g., Olanzapine, Quetiapine, Aripiprazole) are FDA-approved for maintenance therapy.

Q: Which of the following statements is NOT true regarding electroconvulsive therapy (ECT)?

Should not be used in pregnancy. **Explanation:** **1. Why Option C is the correct answer (The False Statement):** Contrary to common misconceptions, **pregnancy is not a contraindication for ECT.** In fact, ECT is considered a **safe and effective treatment** for severe depression, mania, or psychosis during pregnancy, especially when rapid response is needed or when pharmacotherapy poses a higher teratogenic risk to the fetus. With proper fetal monitoring and positioning (to prevent supine hypotension syndrome in later stages), it is often the treatment of choice for psychiatric emergencies in pregnant patients. **2. Analysis of Incorrect Options:** * **Option A:** ECT is indeed mainly used for **Major Depressive Disorder (MDD)**, particularly cases with psychotic features, high suicide risk, or treatment resistance. It is the most effective treatment for severe depression. * **Option B:** It is a high-yield fact that there are **no absolute contraindications** for ECT. Even in high-risk conditions like recent myocardial infarction or increased intracranial pressure, ECT can be administered if the psychiatric risk (e.g., active suicide) outweighs the medical risk, provided there is intensive monitoring. * **Option D:** **Pheochromocytoma** is considered a **relative contraindication** because the surge in catecholamines during the seizure can trigger a hypertensive crisis. Other relative contraindications include recent MI, CVA, and space-occupying lesions (due to increased ICP). **Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves). * **Gold Standard for:** Catatonia and Psychotic Depression. * **Pre-ECT Medication:** Atropine (to decrease secretions/prevent bradycardia), Methohexital/Propofol (anesthesia), and Succinylcholine (muscle relaxant). * **Seizure Duration:** Therapeutic seizure must last at least 25 seconds (motor) or 30-60 seconds (EEG).

Q: A 31-year-old male with a mood disorder, on 30 mg of haloperidol and 100 mg of lithium, presents to the emergency room with acute onset of fever, excessive sweating, confusion, limb rigidity, and decreased communication for one day. Examination reveals tachycardia and labile blood pressure. Investigations show increased CPK enzyme levels and leucocytosis. What is the most likely diagnosis?

Neuroleptic malignant syndrome. ### Explanation The clinical presentation of high fever, "lead-pipe" muscle rigidity, autonomic instability (tachycardia, labile BP, sweating), and altered mental status in a patient taking high-potency antipsychotics (Haloperidol) is a classic description of **Neuroleptic Malignant Syndrome (NMS)**. **1. Why NMS is the Correct Answer:** NMS is a life-threatening idiosyncratic reaction to dopamine antagonists. The pathophysiology involves massive dopamine blockade in the nigrostriatal pathway (leading to rigidity) and hypothalamus (causing dysthermia). Laboratory findings of **elevated Creatine Phosphokinase (CPK)** due to muscle necrosis (rhabdomyolysis) and **leucocytosis** are hallmark diagnostic markers that distinguish it from other psychiatric emergencies. **2. Why Other Options are Incorrect:** * **Lithium Toxicity:** While it causes confusion and tremors, it typically presents with gastrointestinal symptoms (vomiting, diarrhea), ataxia, and coarse tremors, rather than severe "lead-pipe" rigidity and high-grade fever. * **Tardive Dyskinesia:** This is a late-onset extrapyramidal side effect characterized by involuntary choreoathetoid movements (e.g., lip-smacking, tongue protrusion). It does not present with systemic symptoms like fever or autonomic instability. * **Hypertensive Encephalopathy:** While it presents with confusion and high BP, it does not account for the generalized muscle rigidity, elevated CPK, or the specific context of recent antipsychotic use. **3. NEET-PG High-Yield Pearls:** * **Mnemonic for NMS (FEVER):** **F**ever, **E**ncephalopathy, **V**itals unstable, **E**levated enzymes (CPK), **R**igidity. * **Treatment:** Immediate discontinuation of the offending agent, aggressive cooling, and hydration. Pharmacotherapy includes **Dantrolene** (muscle relaxant) or **Bromocriptine** (dopamine agonist). * **Risk Factor:** High-potency typical antipsychotics (Haloperidol) and rapid dose escalation.

Q: A 45-year-old male presented to the emergency department with severe agitation and aggressive behavior. He was treated with haloperidol and became responsive and cooperative. After 8 days of treatment, he developed high-grade fever, diarrhea, confusion, and muscle rigidity. Which of the following should be used for the treatment of this condition?

Dantrolene. **Explanation:** The patient is presenting with **Neuroleptic Malignant Syndrome (NMS)**, a life-threatening idiosyncratic reaction to antipsychotics (like Haloperidol). The clinical tetrad of NMS includes **hyperpyrexia (high-grade fever), muscle rigidity ("lead-pipe" variety), autonomic instability (tachycardia, diarrhea, hypertension), and altered mental status.** **Why Dantrolene is the correct answer:** Dantrolene is a direct-acting skeletal muscle relaxant that inhibits the release of calcium from the sarcoplasmic reticulum. By reducing muscle rigidity and heat production, it addresses the core hypermetabolic state of NMS. Other specific treatments include dopamine agonists like **Bromocriptine** or Amantadine to reverse the dopamine blockade. **Analysis of Incorrect Options:** * **A. Diazepam:** While benzodiazepines are used for mild agitation or to control seizures in NMS, they are not the definitive treatment for the underlying muscle rigidity and hyperthermia. * **B. Benzhexol (Trihexyphenidyl):** This is an anticholinergic used for Acute Dystonia or Parkinsonism. In NMS, anticholinergics can worsen hyperthermia by inhibiting sweating and are generally avoided. * **D. High dose of haloperidol:** This would be fatal. NMS is caused by potent dopamine (D2) blockade; adding more haloperidol would exacerbate the condition. **NEET-PG High-Yield Pearls:** * **Key Lab Finding:** Significantly elevated **Creatine Phosphokinase (CPK)** levels and leukocytosis. * **NMS vs. Serotonin Syndrome:** NMS features "lead-pipe" rigidity and bradyreflexia, whereas Serotonin Syndrome features hyperreflexia and myoclonus. * **First step in management:** Immediate discontinuation of the offending antipsychotic agent and aggressive supportive care (cooling and hydration).

Q: Risperidone is most commonly used to treat which of the following disorders?

Schizophrenia. **Explanation:** **Risperidone** is a second-generation (atypical) antipsychotic. Its primary mechanism of action involves the potent blockade of **D2 (Dopamine)** receptors and **5-HT2A (Serotonin)** receptors. 1. **Why Schizophrenia is correct:** Risperidone is FDA-approved as a first-line treatment for Schizophrenia. By blocking D2 receptors in the mesolimbic pathway, it treats "positive symptoms" (hallucinations/delusions), while its 5-HT2A antagonism in the mesocortical pathway helps improve "negative symptoms" (apathy/withdrawal) and reduces the risk of Extrapyramidal Side Effects (EPS) compared to typical antipsychotics. 2. **Why other options are incorrect:** * **Dementia:** While sometimes used off-label for behavioral disturbances in dementia, it is not the primary treatment. It carries a "Black Box Warning" due to an increased risk of stroke and mortality in elderly patients with dementia-related psychosis. * **Depression:** The first-line treatments are SSRIs/SNRIs. Atypical antipsychotics (like Aripiprazole or Quetiapine) are only used as *adjuncts* in treatment-resistant cases. * **Obsessive-Compulsive Disorder (OCD):** The mainstay of treatment is high-dose SSRIs and Cognitive Behavioral Therapy (CBT). **High-Yield Clinical Pearls for NEET-PG:** * **Hyperprolactinemia:** Among atypical antipsychotics, Risperidone has the **highest risk** of increasing prolactin levels (leading to gynecomastia, galactorrhea, and amenorrhea) because it behaves like a typical antipsychotic at higher doses (>6mg). * **Metabolic Profile:** It carries a moderate risk for weight gain and metabolic syndrome (less than Olanzapine, but more than Ziprasidone). * **Active Metabolite:** **Paliperidone** is the active metabolite of Risperidone.

Q: A patient was on treatment with trifluoperazine for some time. He presents with a complaint of hyperthermia, lethargy, and sweating. Which investigations are needed?

Hemogram, CPK and renal function test. ### Explanation The clinical presentation of **hyperthermia, lethargy, and sweating** in a patient taking **Trifluoperazine** (a high-potency typical antipsychotic) strongly suggests **Neuroleptic Malignant Syndrome (NMS)**. NMS is a life-threatening idiosyncratic reaction to dopamine antagonists. **Why Option D is Correct:** To confirm the diagnosis and assess the severity of NMS, specific laboratory investigations are critical: * **Hemogram:** Typically shows **leukocytosis** (elevated WBC count), which is a diagnostic marker for NMS. * **Creatine Phosphokinase (CPK):** Severe muscle rigidity (lead-pipe rigidity) leads to muscle necrosis, causing a significant **elevation in serum CPK levels**. * **Renal Function Test (RFT):** Massive muscle breakdown leads to **myoglobinuria**, which can cause **Acute Renal Failure**. Monitoring BUN and Creatinine is vital for management. **Why Other Options are Incorrect:** * **Option A:** CT Scan is used to rule out structural brain lesions or strokes, which do not typically present with this triad of symptoms. * **Option B:** While electrolytes are important in any systemic illness, they are not specific diagnostic markers for NMS compared to CPK. * **Option C:** ECG and Chest X-ray are supportive but do not aid in the primary diagnosis of NMS or the assessment of its most common complication (rhabdomyolysis). **Clinical Pearls for NEET-PG:** * **Mnemonic for NMS (FEVER):** **F**ever, **E**ncephalopathy (lethargy), **V**itals unstable, **E**levated enzymes (CPK), **R**igidity. * **Drug of Choice:** **Dantrolene** (muscle relaxant) or **Bromocriptine** (dopamine agonist). * **Key Difference:** Unlike Serotonin Syndrome, NMS is characterized by **"Lead-pipe" rigidity** and **bradyreflexia**, whereas Serotonin Syndrome presents with hyperreflexia and myoclonus.

Question 1

A 30-year-old man, recently started on haloperidol 30mg/day, developed hyperpyrexia, muscle rigidity, akinesia, mutism, sweating, tachycardia, and increased blood pressure. Investigations showed increased WBC count and increased creatinine phosphokinase. There is no history of any other drug intake or any signs of infection. What is the most likely diagnosis?

Accepted Answer

Neuroleptic malignant syndrome

Answer

Drug overdose

Answer

Drug-induced Parkinsonism

Answer

Tardive dyskinesia

Question 2

Retrograde ejaculation is a characteristic side effect of which psychotropic medication?

Accepted Answer

Thioridazine

Answer

Lithium carbonate

Answer

Phenelzine

Answer

Diazepam

Question 3

Which of the following medications are used in the treatment of hyperkinetic syndrome?

Accepted Answer

Methylphenidate and Amphetamine

Answer

Imipramine and Methylphenidate

Answer

Imipramine and Clozapine

Answer

Haloperidol and Clozapine

Question 4

What is the best drug therapy for paranoid schizophrenia in a thinly built 21-year-old young male?

Accepted Answer

Olanzapine

Answer

Chlorpromazine

Answer

Risperidone

Answer

Quetiapine

Question 5

A 26-year-old lady has just recovered from an acute manic episode and has a diagnosis of bipolar affective disorder. Which one of the following medications is not used for the prophylaxis of this condition?

Accepted Answer

Chlorpromazine

Answer

Carbamazepine

Answer

Lithium

Answer

Semisodium Valproate

Question 6

Which of the following statements is NOT true regarding electroconvulsive therapy (ECT)?

Accepted Answer

Should not be used in pregnancy

Answer

Mainly used for the treatment of major depressive disorder

Answer

No absolute contraindications exist for the use of ECT

Answer

Pheochromocytoma is a relative contraindication

Question 7

A 31-year-old male with a mood disorder, on 30 mg of haloperidol and 100 mg of lithium, presents to the emergency room with acute onset of fever, excessive sweating, confusion, limb rigidity, and decreased communication for one day. Examination reveals tachycardia and labile blood pressure. Investigations show increased CPK enzyme levels and leucocytosis. What is the most likely diagnosis?

Accepted Answer

Neuroleptic malignant syndrome

Answer

Lithium toxicity

Answer

Tardive dyskinesia

Answer

Hypertensive encephalopathy

Question 8

A 45-year-old male presented to the emergency department with severe agitation and aggressive behavior. He was treated with haloperidol and became responsive and cooperative. After 8 days of treatment, he developed high-grade fever, diarrhea, confusion, and muscle rigidity. Which of the following should be used for the treatment of this condition?

Accepted Answer

Dantrolene

Answer

Diazepam

Answer

Benzhexol

Answer

High dose of haloperidol

Question 9

Risperidone is most commonly used to treat which of the following disorders?

Accepted Answer

Schizophrenia

Answer

Dementia

Answer

Depression

Answer

Obsessive-compulsive disorder

Question 10

A patient was on treatment with trifluoperazine for some time. He presents with a complaint of hyperthermia, lethargy, and sweating. Which investigations are needed?

Accepted Answer

Hemogram, CPK and renal function test

Answer

CT Scan brain & hemogram

Answer

Hemogram, Electrolyte level and creatinine

Answer

ECG, Chest X-ray and hemogram

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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